Organization
SHEPHERD'S CARE HOSPICE OF WAGONER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEENA K. BOTTOM RN, MS ,CHN (PRESIDENT)
(918) 485-4673
Entity
Organization
Contact information
Practice address
611 W CHEROKEE ST, WAGONER, OK 74467-4618
(918) 485-4673
Mailing address
611 W CHEROKEE ST, WAGONER, OK 74467-4618
(918) 485-4673
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
4177
OK
Other
Enumeration date
04/10/2006
Last updated
08/22/2020
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